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Planning for a pregnancy when you have diabetes

Most women with diabetes have a healthy baby.

But having diabetes means that you and your baby are more at risk of serious health complications during pregnancy and childbirth.

The good news is that by planning ahead and getting support from your GP and diabetes team, you can really reduce the risks involved. So you’re more likely to enjoy a healthy pregnancy and give birth to a healthy baby.

That’s why it’s really important to use effective contraception (birth control) until you want to try for a baby. This can give you time to plan and prepare. Talk to your GP or nurse about choosing the type of contraception that works best for you.

Your checklist for a healthy pregnancy

Start taking the following steps to help you prepare for a healthy pregnancy:

You’re not on your own, there’s lots of support to help you. You’ll get this from your healthcare team, but talk to your family and friends too.

We’re here to help support you. We have lots of useful information to help you plan a healthy pregnancy, and if you still have more questions, give our helpline a call. Our helpline has highly trained advisors with counselling skills, and an extensive knowledge of diabetes to talk things through with you.

You could also try this Planning for Pregnancy tool created by Tommy’s – a charity dedicated to making pregnancy safer. It'll help you learn what you need to know.

There are risks involved, but knowing what they are means you can take steps to reduce them. Let’s talk about the risks:

You could have a miscarriage

You may have problems with your eyes and kidneys

It’s more likely you’ll have a larger baby – this can make the birth more painful and possible stress for the baby. So you may need a caesarian (C-section).

Your baby may be born with serious health problems, such as spina bifida. This is where the baby’s spine doesn’t develop properly.

There is also a risk of stillbirth, or your baby dying at around the time of birth. This is rare, but there’s more risk for women with diabetes.

But remember, you can greatly reduce these risks by planning ahead and getting support. Giving yourself enough time to prepare and look after yourself can help you on your way to having a healthy pregnancy and a healthy baby.

If you think you might be pregnant already, contact your GP or diabetes team as soon as possible. They are there to help and will be able to give you advice and support. And don’t forget, we have more information to help you during your pregnancy.

As soon as you start thinking about having a baby, it’s very important to make an appointment with your GP or nurse. They can give you advice and will refer you to a pre-conception clinic.

The clinic is usually run by a diabetes midwife and a Diabetes Specialist Nurse. Here you’ll get information about managing blood sugar levels, which medication you need to change or stop, taking folic acid, and how to plan for any problems that might happen.

Women with diabetes are 5x more likely to have a pre-term baby

Knowing what to expect when you're pregnant, and after the birth will help you plan a healthy pregnancy. It’s not just about understanding how diabetes affects pregnancy, but also how pregnancy affects diabetes.

You’re more likely to have a healthy baby if you manage your blood sugar levels before you get pregnant, as well as during pregnancy.

Your HbA1c

You’ll need to get your HbA1c checked before you stop using contraception. This is because a high HbA1c level can affect how a baby develops. This is really important in the first trimester (first 8 weeks of pregnancy), because the baby’s organs are developing.

It’s safest to keep your HbA1c level below 48mmol/mol.

If yours higher than 48mmol/mol, taking steps to safely bring it down will help reduce your risks. But if your HbA1c is over 86mmol/mol, it’s not safe to get pregnant and you should talk to your healthcare team for advice.

Your blood sugar levels

You’ll also need to check your blood sugar levels more regularly at home. This is so you can try to keep them in a safe range during the day.

If you have Type 1 diabetes, you’ll already have a blood sugar testing kit, but make sure it checks for ketones too.

If you have Type 2 diabetes and don’t have a blood sugar testing kit, ask your diabetes team for one.

Here’s an example of some targets to aim for:

when you wake up and haven’t eaten yet – 5 to 7mmol/l

before meals at other times of the day – 4 to 7mmol/l

90 minutes after meals – 5 to 9mmol/l.

Your diabetes team can help you set these targets – they may be different depending on your situation. They can also help you reach these targets, so you can reduce the risks for you and your baby.

Some diabetes medications aren’t safe to take when you’re planning a pregnancy. You’ll need to get advice from your GP or nurse about which ones to stop. Metformin and insulin are safe to take.

If you’re taking certain medications to treat other health conditions, you might need to stop these too. These include:

statins

ACE inhibitors

other blood pressure tablets.

Tell your doctor if you take any of these. They will be able to give you advice about stopping or changing your medication.

After your baby is born, you can usually go back to the medication you were taking before. But if you’re breastfeeding, stick to your doctor’s advice and keep avoiding all the medication you stopped taking before you were pregnant. If you were taking glibenclamide, it’s safe to start taking that again.

Your doctor or nurse will prescribe you a high-dose folic acid (5mg) to take as soon as you decide you want to get pregnant. You should be taking folic acid 5mgs each day at least 12 weeks before you conceive as this also reduces the risks to your baby. You’ll then need to keep taking this until you’re 12 weeks pregnant.

This higher dose of folic acid is only available on prescription. You can’t buy it over the counter.

Pregnancy can make some diabetes complications worse, such as eye and kidney problems. So it’s really important to have eye screening and tests for your kidneys before you stop using contraception. Eye problems because of diabetes (diabetic retinopathy) can be treated if caught early, so screening is really important.

Your diabetes team can arrange this and they’ll talk to you about the results. In some cases, you may be referred to a specialist team for extra support.

Get support from family and friends

Deciding to try for a baby is just as exciting for you as it is for everyone else. And there’s every reason to look forward to a successful pregnancy and a healthy baby.

But having diabetes means there are more risks involved. It’s harder work as a result – with more checks, appointments and scans. And keeping very tight control of your blood sugar levels can be tiring and stressful at times.

If you have a partner, it’s a good idea to explain all this so they can support you from the beginning. Or ask your friends or family to give you that extra support.

You’re not alone in this and we’re here to help too. You can call our helpline and talk to us about anything you’re worried about or struggling with. Our trained advisors will be able to give you more information and support.